Bradley JD, Brandt KD, Katz BP et al.
The New England Journal of Medicine, 1991;325:87-91.

Osteoarthritis (OA) is one of the most common joint diseases and the inflammation associated with it is usually treated with NSAIDs. It has not been clearly demonstrated, however, that analgesics without anti-inflammatory properties are less effective for treating OA. A randomized, double-blind study compared the use of acetaminophen, an analgesic, and ibuprofen, a nonsteroidal anti-inflammatory, for the short-term, symptomatic treatment of osteoarthritis (OA) of the knee. Patients received either 4,000 mg of acetaminophen (n = 61) a day or ibuprofen 2,400 mg (n = 61) or 1,200 mg (n = 62) of ibuprofen a day. Treatment was for four weeks. Outcome measures included scores on the pain and disability scales of the Stanford Health Assessment Questionnaire and the physician's assessment of the patient's arthritis. At the end of four weeks there were no major differences between the three groups in terms of trial completion because of compliance and adverse events. The average improvement in the scores on the pain scale of the Health Assessment Questionnaire was 0.33 with acetaminophen, 0.30 with low-dose ibuprofen (1,200 mg), and 0.35 with high dose ibuprofen (2,400 mg). The incidence of side effects was minor and similar in all three groups. While this study only evaluated the short-term treatment of OA of the knee, results question the routine use of a high dose of ibuprofen for treating OA of the knee. Acetaminophen has similar efficacy to that of ibuprofen for the short-term, symptomatic treatment of OA of the knee.

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